Olanzapine, Risperidone Tied to Weight Gain in Autism

Certain second generation antipsychotics used to address irritability in patients with autism spectrum disorder (ASD) are more likely to cause weight gain than others, according to study results published in the Journal of Child and Adolescent Psychopharmacology.

Several second-generation antipsychotics have been approved to treat irritability, including aggression, self-injury, and severe tantrums in this population. However, the class of drugs is often associated with changes in glucose and lipid metabolism, weight gain, and poor cardiovascular outcomes.

In order to determine which drugs were more detrimental, researchers from the Cincinnati Children's Hospital Medical Center conducted a chart review of 202 patients with ASD aged 2 to 20 years. The patients were treated with one of 5 second generation antipsychotics – risperidone, aripiprazole, olanzapine, quetiapine, or ziprasidone – for a maximum of 4 years.

The researchers found that treatment with risperidone, aripiprazole, and olanzapine resulted in a significant increase in body mass index (BMI) z-score (P= .03, .05, and <.01, respectively). Olanzapine was associated with the greatest increase in BMI z-score compared to all other second generation antipsychotics (all P<.05), while ziprasidone and quetiapine were not associated with an increase in BMI z-score (P= .47 and .11, respectively). The results remained the same after adjusting for weight-gain attenuating concomitant medications.

“Caregivers treating children and teens with ASD, and parents, can use this information to balance the risks and benefits of SGAs for treating irritability associated with autism spectrum disorders," Logan Wink, MD, of Cincinnati Children's Hospital, said in a statement. “Given that this was a chart review, our results must be considered along with its limitations," Dr Wink said. "We believe, however, that this study adds to the growing safety data regarding use of SGAs and lays the ground work for future controlled head-to-head analysis of SGA treatment in ASD patients."